Long Road Home


AUTHOR: Debbie Mraz
EMAIL: dmrazcmt@aol.com
CATEGORY: JC
RATING: Mostly PG, but some NC-17
SPOILERS: Post stabbing
DISCLAIMER: These characters do not belong to me, I am borrowing them for a while and they will be returned virtually unharmed at the end of their journey…..
AUTHOR'S NOTE: I know there has been some controversy regarding the amount of post-stabbing fics out there, but I never tire of reading any of the fanfics, and I am not tired of the post-stabbing fics. Therefore, I wish to add to the collection…
SUMMARY: This is a post-stabbing fic. Complications arise as Carter struggles to regain his "normal" life.



As John prepared to leave after his shift, he stopped off at the lounge to give his aching back a rest. He started feeling a little short of breath this morning before he arrived at the hospital, but continued his shift, without so much as a word of complaint. John didn't feel that he had a "right" to complain, after all, he was the one still alive. He still felt an incredible amount of guilt over Lucy's death, and he thought he deserved every bit of pain he was suffering. He felt it was his punishment.

"Carter, you going home yet?" Carol asked.

"Yeah, just catching my breath before I make my way out." John replied.

"Hang on a second, I'll walk out with you okay?"

"Sure Carol, I'll be here."

Carol made her way out to the desk and noted that Luka was still on duty. They looked up simultaneously, as John walked past the desk and toward the lounge. He seemed to be limping more than usual today, as well as looking like he hadn't slept in days. The circles under his eyes were turning a purplish color, and he wasn't bouncing back like they had all thought he would.

"Luka, have you noticed that Carter seems awfully short of breath today?" Carol asked.

"I did, yes, and I asked him about it earlier in the shift." Luka replied.

"What did he tell you?"

"He said he thought it may be a cold coming on, and then politely told me to mind my own business."

"Well, that doesn't surprise me. He just hasn't been himself." Carol said as she walked toward the lounge to see if John was ready to leave for the day.

*********************************************************************************

John was sitting next to his locker, trying to catch his breath. It seemed like any movement, no matter how small, hurt like hell. He could handle the pain part, but not being able to catch his breath was getting annoying. He stood and gazed at his reflection in the mirror hanging in his locker. "You look awful," he said out loud, then quickly looked around to make sure no one else was in the room. He knew his co-workers already thought he was a little goofy in the head. He didn't want to add to this by being caught talking out loud to himself.

He looked again at himself in the mirror and noticed that his lips were a bit blue. This was worrisome. He took a few deep breaths and proceeded to slip on his coat. He picked up his bag and slung it over his shoulder. This simple motion had him winded and he again sat down to catch his breath. He was sitting down with his eyes closed when Carol walked into the lounge.

"Carter, what's wrong?" Carol asked with alarm.

John's eyes snapped open as he replied, "Nothing Carol, just a little tired and ready to go home."

*********************************************************************************

They walked past the desk and John signed out. They made their way out the ER doors and out toward the El station. Carol caught a few glances over at him and commented that he should get more sleep.

"Yeah sure," John thought to himself, "that's all I need, now if I could only get the image of Lucy lying in a pool of blood out of my head, that seem to appear every time I close my eyes, then I guess sleep would be good."

They rode most of the way in silence, as John found that speaking made him more short of breath. Carol had attempted conversation, but after several one-word responses out of John, she stopped trying.

They had almost reached Carol's stop. She turned to John and noticed that his lips were slightly blue, as were his nail beds.

"Carter, are you okay?" She asked for the second time that day. "You don't look well."

"Yeah Carol I'm fine, my back just hurts and I want to go home and lie down." He replied.

"Hey Carter, why don't I ride to your stop with you? It would make me feel better to know you got home safely."

"Not necessary Carol."

"Well, it's really not that far out of the way, no big deal."

"Thanks, but no, I'm fine."

As they reached her stop, Carol stepped off the El and said goodbye. She had a bad feeling about leaving him alone. Kerry and Mark had told everyone to leave Carter alone. Carter himself, had made it perfectly clear to everyone that he was capable of taking care of himself and neither wanted nor accepted help. He seemed like such a different person. She rarely saw him smile anymore, and whether John Carter knew it or not, he was one of those people who wore their feelings on their sleeve. You could tell just by looking at him what kind of a mood he was in. His face had been unreadable for the past three weeks, and Carol reasoned that maybe he just didn't know how he felt right now. She tried to leave him alone, but let him know that she was available if he needed to talk. He had not taken her up on that, or anyone else who offered a listening ear for that matter. He refused to go to counseling, although he was aware that almost all of the other ER staff had talked to one of the staff psychiatrist's about the incident. Carol felt like she was walking on eggshells with Carter lately. He snapped at co-workers, and had put up such a wall around himself, that it had become uncomfortable to even be around him. Still, she felt bad for leaving him along on the El.

*********************************************************************************

John hoped a seat would become available. It hurt to breathe and he just wanted to sit and catch his breath. He started mentally going over all of the reasons why he was feeling so bad. He had subjective fevers for the past few days. He had not actually put a thermometer under his tongue. He was also dizzy, not just if he stood up too fast, but he even had a vague dizzy feeling no matter what he was doing.

He had been finding it more difficult to breathe today, and deduced that he must be getting a chest cold, maybe bronchitis. He hadn't been taking care of himself and knew he was more susceptible to infection. He continued to attempt to take deep breaths, thinking this would help if he had a pneumonia or bronchitis, at least that what he would tell a patient with the same symptoms. He wished a seat would open up, until it did, he would just continue holding onto the pole and try to concentrate on how many more stops until he was home.

"Mister are you okay," a lady asked him, "you don't look so good."

"I'm……o…kay." John replied breathlessly. He rubbed his hand over his forehead and noted that he was sweating profusely. Pain seized his chest and a panic washed over him. He couldn't breathe. He felt as if he were drowning.

Pride definitely had its downside. John felt nauseous, and thought he should have let Carol help him out by making sure he arrived home safely.

That was his last conscious thought as he felt himself sliding down the pole he was holding onto for dear life, toward the floor of the train.

*********************************************************************************

"Hey, hey mister, hey somebody help!" the lady next to John yelled for some assistance.

Someone pulled the cord to stop the train and some of the passengers voiced their complaint about the sudden stop.

"I think this guy is dead!" Another passenger called.

"Anybody have a cell phone?"

Another passenger made his way through the crowd toward John's still form. "I'm a nurse, stand back, stand back please so I can see what's going on here!" He called to the small crowd gathering around John.

He turned John over on his back, took of his coat and bag with the help of another passenger. He felt John's neck for a carotid pulse, felt none. He leaned his head forward and put his ear on John's chest to assess for breath sounds, and heard none. He called, "No pulse, no respiration, anyone else here know CPR?" The nurse quickly took off John's tie and unbuttoned his shirt. "Someone call 911!" He yelled.

"I have an operator on the line now, does anyone know exactly where we are?"

Overhead, the speaker crackled with an angry voice, "What's the problem back there! Who pulled the cord!"

"We have a man down, we have 911 on the line and need to know our exact location."

"We're almost at 7th and Wabash. What exactly is the problem?" the El operator's voice called back.

"We have a young man, looks around 30 or so, currently not breathing and has no heart beat, a nurse on board has started CPR, but we need to get this guy to a hospital!" Another passenger yelled.

The nurse stopped CPR momentarily to check for a pulse and respiration. "Still no pulse, no respiration, continuing CPR," the nurse called out.

The location information was relayed to the 911 operator who reassured that the paramedics would be waiting at the platform of 7th and Wabash, and asked of the status of the victim.

"Still not breathing and no pulse."

"Is there any identification on the man?" asked the operator.

"Hey, can someone see if this guy has a wallet or something so we know who he is. 911 asked if we had a name so his family could be notified," the gentleman with the cell phone called out to anyone near enough to check.

The lady who was seated next to John looked first in his coat pocket, and pulled out his ID badge from the hospital. "Tell them I found an ID badge is his pocket that says his name is John Carter, M.D. He works at County."

The man with the cell phone relayed the information to the 911 operator, who in turn told him to stay on the line until the paramedics arrived.

It took less than a minute to arrive at the next station, where the paramedics awaited the arrival of the train. One of the paramedics took over chest compression for the grateful nurse, whose arms felt like rubber after 12 minutes of continuous CPR. "How long has he been down?" asked the paramedic.

"My best guess would be 13 minutes. I counted 12 minutes of CPR and he was probably down about a minute before I started," the nurse relayed.

The paramedics did a quick assessment, removed John's shirt and restarted CPR. They lifted John onto the gurney and placed him in the ambulance. As the ambulance pulled away, the small crowd that had gathered dispersed as the El continued on it's scheduled route.

The paramedics called in to County to alert them of the impending arrival.

"County, this is rig 12, we're on our way in with what looks like one of yours, name badge from County says, John Carter, M.D. Found down on the El. He's in full cardiopulmonary arrest, over."

"12 this is County, we read you loud and clear, any idea what happened?" Mark asked.

"Not really County, appears he just passed out, but a passenger sitting next to him says he was sweating and his lips were blue just before he went down."

"How long has he been down?" Mark asked.

"About 13 minutes County. CPR was started after he had been down approximately a minute according to another passenger. ETA now 1 minute County."

*********************************************************************************

Mark called out to clear trauma 1 ETA of 1 minute. "Kerry, could I see you for a second?"

"What's up Mark?"

"Kerry, the patient coming in is…." Mark was interrupted by the ambulance bay doors swinging open. Kerry hurried to catch up with the gurney headed for the trauma room.

"What have we got," Kerry called, as she looked at the patient's face and realized it was John. "Oh my God," Kerry said, "what happened?"

"We got a young male, apparently one of yours, found down on the El. Passenger says his lips were blue and he was sweating when he fell to the ground. He's been in full cardiopulmonary arrest since, down now approximately 16 minutes. No BP or pulse, no spontaneous respiration, pupils fixed, but not dilated. No response to painful stimuli. IV of D5W with 20 of K started wide open on the left, 20 gauge on the right with Diltiazem bolused at 20 mg, repeat bolus given at 25 mg, then left at 10 mg drip, and 5 mg total of Epi given en route with no response" the paramedic relayed.

"On my count, 1, 2, 3" Kerry said as they moved John over.

Mark entered the room, gowned and called for CBC, Lytes, BUN, Chem-20 and ABG's stat. "Get a portable x-ray in here too! Come on people let's move!" he called.

"Kerry, we need to get him intubated, do you want me to do it?"

"No, I've got it." Kerry replied. She proceeded to intubate John as Malik continued chest compressions. "I'm in, Abby, bag him." Kerry ordered.

She quickly made her way to the crash cart charged to 200 and yelled, "Clear!" Malik moved out of the way, then restarted chest compressions.

"Giving 2 mg of Epi, we're still in asystole." Mark called.

Again Kerry yelled, "Charge to 300 and clear!" They all watched as John's body convulsed again, yet his EKG was still flat lined.

"Again, clear!" Kerry called again. This time, the EKG showed some electrical activity.

"We have a rhythm." Mark called.

Chuny entered the room and read off lab results, "Crit is 14, potassium is 2.4 Mark."

"Kerry, he's bleeding out from somewhere." Mark said.

"Give 2 meq of potassium IV. Get some O negative on the rapid infuser, I want a portable chest film in here now! And somebody page Benton down here, he's bleeding out from somewhere." Mark yelled.

The x-ray technician entered the room and quickly set up for a portable chest film. "Shooting" she called.

"I want those films stat please." Kerry called to the tech.

The tech brought back the films and Mark and Kerry put them up on the box. "Oh man," Mark said, "where the hell is Benton! This looked like his pulmonary artery is perforated, and it looks like he's got a rib or two broken."

Mark walked out of the trauma room to see where Benton was and have him re-paged when he saw him walking toward the desk.

*********************************************************************************

Peter Benton had just sat down to a much needed break, when his pager went off. He got up and quickly made his way toward the ER.

"You have a surgical consult?" He asked.

"Sure do Peter, trauma 1," Mark said, "it's Carter."

Peter stepped up his pace and asked, "What the hell happened?"

"He was on his way home on the El, when, according to another passenger, his lips turned blue, he started sweating and collapsed to the floor. He was in full cardiopulmonary arrest when he arrived. He was down for approximately 18 minutes total time. X-rays look like he has a perforated pulmonary artery." Mark replied.

Peter and Mark quickly made their way toward the trauma room. Peter looked over the films and asked Mark if he had done an echo yet. He hadn't and Peter ordered a stat echocardiogram. He looked at his former student, and wondered how in the hell he had missed this. John had mentioned to Peter more than once that he was having a hard time catching his breath for the past few weeks. Peter's advise had been to take deep breaths. He also told him it would take a while for him to heal completely, and to take it easy, which John had not done.

The echocardiogram showed an aorto-pulmonary fistula, with an aortic artery perforation as well as pulmonary artery perforation. "This explains his shortness of breath, I can't believe he didn't have any other symptoms." Peter said.

"I didn't realize Carter was having any trouble breathing did you Kerry?" Mark asked.

"He did seem like he was having some difficulty today, but he told me he thought he was getting a chest cold, and I let it go." Kerry responded.

"Okay people let's get him upstairs, can we get a vent down here?" Peter asked.

Abby retrieved the portable ventilator, and with Kerry's help, calculated the correct settings. Abby hooked the ET tube into the vent as Kerry again, checked his pupils for any response, of which there was none.

"Jerry, call upstairs and make sure there' s an OR ready, I need you to page Dr. Romano to the OR stat!" Peter barked.

**********************************************************************************

Peter knew that sometimes stabbing victims developed problems months after the initial injury, but that knowledge didn't make him feel any better considering that John was his patient, and he had missed this. It was inexcusable. John told him about the shortness of breath weeks ago, and Peter just didn't put it together. He also knew that the morbidity rate of aorto-pulmonary fistula repair was extremely high. This combined with the fact that John had been down almost 18 minutes didn't bode well for a successful repair, but Peter had to try. After all, had he listened to his patient, he might not be in this condition.

Peter gave new orders for the ventilator settings, and went to scrub for surgery.

Dr. Romano entered the operating suite, and immediately asked drilled Peter, "How the hell did this happen good Dr. Benton? Didn't he see you postoperatively? Did you not examine him? Do you have any idea of the morbidity of this procedure Peter?" Romano asked.

"Yes, I do and no I didn't catch this Dr. Romano. He had no symptoms up until today." Peter glossed over the fact that John had complained of shortness of breath several times in the last few weeks.

"OK Peter, this is your show, let's go try to save Carter's life." Romano stepped into the operating room, followed by Peter.



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